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of the hip joint. The primary goal of surgery in acetabular fractures is the anatomic reconstruction of the articular surface to avoid long-term complications such as posttraumatic osteoarthritis with the need for arthroplasty. This is of great
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.9–7.3 million cases annually by 2050. 1 – 3 , 7 – 9 Numbers of annual hip fracture cases treated are: UK 100,000, 4 Germany 135,000 10 and Netherlands 18,500 11 respectively. This increase is linked to a growing ageing global population that
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The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness.
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Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a ‘best-case’ scenario there can be complications in the long term.
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In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle.
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The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications.
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ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues.
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Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time.
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The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs.
Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
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Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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). Intertrochanteric fractures (ITF), accounting for approximately half of all hip fractures ( 3 ), are treated using intramedullary femoral nails with increasing frequency ( 4 , 5 , 6 ). While the principles of ITF stabilization via femoral nailing remain consistent
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region also experiences secondary forces from the numerous muscular attachments found in the area, which increase stress around the proximal femur and hip. 6 These muscular attachments include the hip abductors, adductors, short external rotators
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ilioinguinal approach does not allow any visualization of the hip joint itself, therefore the correct reduction of the articular surface must be verified using absolute anatomic reduction and alignment of all accessible fracture lines as well as fluoroscopic
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Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, UAE
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the model of primary hip or elbow arthroplasties for fracture. It is often used as a last resort in the treatment of failed fixation of complex knee fractures. 4 , 5 The main advantages of primary arthroplasty are the ability to preserve joint
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sliding hip screw set. 3 , 4 The reduction of the articular surface congruency can be assessed either indirectly (arthroscopically or under fluoroscopy) or directly by an arthrotomy of the joint and direct visualisation of the affected area. Fixation
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comorbidities 33 results in a better outcome, with a lower 30-day mortality among patients with hip fractures. 34 It is recommended that the leadership of the interdisciplinary team should remain with the trauma surgeon. Long-term care The
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dome are fundamental to successful joint congruence and permit normal transfer of body weight. 10 , 11 Unsatisfactory reductions result in chronic hip pain and limited movement. The interval between fracture and surgery affects fracture reduction
